Deck 14: Clients Having Surgery

Question 1

The item most likely to be left in place when the client is sent to the operating room (OR) is

A) an engagement ring.
B) a hearing aid.
C) a wig.
D) well-fitting dentures.

Answer 1

a hearing aid.

Question 2

During the preoperative interview, the client's statement that would alert the nurse to an increased risk during surgery is "I

A) am a reformed smoker; I haven't had a cigarette in 10 years."
B) rarely eat red meat; it usually makes me feel bloated."
C) take a couple of aspirin every day for my headaches."
D) take a large assortment of vitamins daily."

Answer 2

take a couple of aspirin every day for my headaches."

Question 3

The client who has received odansetron (Zofran) asks, "What will the drug do?" The nurse should base a reply on the knowledge that odansetron

A) controls intraoperative secretions.
B) produces an antiemetic effect.
C) promotes rapid sedation.
D) relieves postoperative pain.

Answer 3

produces an antiemetic effect.

Question 4

A client who is extremely overweight has been advised to lose weight before surgery. To encourage the client, the nurse knows that the most appropriate statement is

A) "It will decrease the operating room time by half if you lose weight."
B) "Surgery requires more anesthesia if you are overweight."
C) "With the weight loss, you decrease the chance of complications after surgery."
D) "You'll feel better after surgery if you lose the weight before."

Question 5

When teaching the proper method of coughing, the nurse should instruct the client to

A) breathe in and out through the nose.
B) deep-breathe after coughing.
C) relax the abdominal muscles.
D) splint the incision.

Question 6

Before administering the preoperative medication, the nurse should

A) ensure that the permit has been properly signed.
B) have the unlicensed assistive personnel call for transportation.
C) make sure there is nothing else left to do.
D) take and record a set of vital signs.

Question 7

The nurse explains to a preoperative class of six clients awaiting surgery that studies indicate the primary benefit of the class is to

A) distribute information to the most individuals in a short time.
B) explain legal responsibilities.
C) promote a less complicated postoperative course.
D) provide uniform information.

Question 8

Which action should receive high priority in an elderly client being placed on the operating room table?

A) Attach the client to a cardiac monitor.
B) Ensure that the correct operative site is exposed.
C) Provide extra padding for joints and bony prominences.
D) Understand which anesthetic agents are being used.

Question 9

The nurse caring for a client who had spinal anesthesia will ensure that the plan of care includes

A) administering oxygen to reduce the hypoxia produced by spinal anesthesia.
B) elevating the client's feet to increase the blood pressure.
C) elevating the head of the bed to decrease nausea.
D) instructing the client to remain flat in bed for 6 hours.

Question 10

A client scheduled for a dilation and evacuation following a miscarriage is visibly upset and states that she is frightened and does not know what to expect. The perioperative nurse best demonstrates understanding of the situation by saying

A) "I'll give you something to help you relax."
B) "Let me explain what is going to happen."
C) "This is a simple procedure; it will be over in no time."
D) "You're still young, and you can have more children."

Question 11

The nurse will plan preoperative teaching about how to cough and deep-breathe for

A) 1 week before the procedure.
B) immediately postoperatively.
C) the afternoon before surgery.
D) the nurse's first discussion about the surgery.

Question 12

The most appropriate explanation by the nurse to explain why a client cannot eat before surgery is

A) "Anesthesia works best on an empty stomach."
B) "The stomach should be empty to prevent complications."
C) "There is not enough time before surgery to digest the food."
D) "You will not have to go to the bathroom frequently before surgery."

Question 13

The methodology likely to be most effective in meeting a client's teaching/learning needs preoperatively is

A) teaching only the client.
B) teaching the client and family.
C) using brief verbal instructions.
D) using only written instructions.

Question 14

To lessen the postoperative complication of thrombophlebitis, the nurse would

A) assist the client to sit up in bed after surgery.
B) maintain the legs in an elevated position.
C) massage the client's legs.
D) remind the client to exercise the legs and feet.

Question 15

After administration of preoperative medications, the nurse takes the precaution of

A) confirming that the client has voided.
B) monitoring vital signs every 15 minutes.
C) placing the client in bed with the rails up.
D) transporting the client immediately to the OR.

Question 16

A client is receiving anesthesia and is being inducted just before an operation. The most appropriate action by the nurse at this time is to

A) apply wrist and leg restraints to ensure client safety.
B) begin counting supplies with the surgical technician or scrub nurse.
C) ensure all conversation in the operating room is appropriate.
D) monitor the client for agitation and struggling.

Question 17

The nurse explains to a client that because of alterations in liver function caused by cirrhosis, the client is predisposed to postoperative fluid shifts and wound infection related to

A) elevated creatinine phosphokinase levels.
B) elevated lactic dehydrogenase levels.
C) low albumin levels.
D) low blood urea nitrogen levels.

Question 18

Preoperative assessment data that should be reported to the surgeon include

A) complaining of mild anxiety.
B) having a sore throat.
C) potassium level within normal range.
D) using acetaminophen for headaches.

Question 19

During the operative period, a client under general anesthesia experiences masseter muscle rigidity. The nurse-anesthetist recognizes this to be a manifestation of

A) excessive heat loss.
B) malignant hyperthermia.
C) need for increased muscle relaxant.
D) onset of anesthesia.

Question 20

The preoperative assessment finding that the nurse would report to the surgeon for preoperative treatment is

A) hemoglobin concentration of 13.5 mg/dl.
B) partial thromboplastin time of 25 seconds.
C) potassium level of 3.0 mEq/L.
D) sodium level of 140 mEq/L.

Question 21

During preoperative teaching, the nurse advises the client who smokes on an important health promotion measure to take before elective surgery, which is to

A) ask the physician for nicotine patches.
B) cut down by half the amount smoked per day.
C) increase fluid intake to reduce risk of thrombosis.
D) stop smoking at once.

Question 22

The PACU nurse is informed that the client being admitted has not recovered his pharyngeal reflex. The nursing action that should receive greatest priority is to

A) check for the gag reflex frequently.
B) maintain an oral airway.
C) remain with the client at all times.
D) suction the client frequently.

Question 23

In the first 3 days after surgery, the nurse would anticipate the fluid and electrolyte adjustment of

A) elevated hematocrit level.
B) fluid retention.
C) increase in serum potassium level.
D) increased urine output.

Question 24

On the preoperative assessment, the nurse notes the suggestion of susceptibility to malignant hyperthermia during surgery in the client's statement that

A) "I frequently have numbness and tingling in my hands."
B) "I usually feel very warm and tend to perspire heavily."
C) "My mother died from anesthesia problems."
D) "On occasion I've had muscle tenderness around my jaw."

Question 25

For a client admitted to the PACU with an oral airway in place, the nursing intervention that would be inappropriate is

A) allowing the client to spit out the airway.
B) removing the airway when the client becomes responsive.
C) suctioning the client's secretions as needed.
D) taping the airway in place so it does not fall out.

Question 26

A client calls the Telehealth nurse on the third postoperative day and describes a "giving way" sensation in the abdomen that occurred after coughing. To assess for a possible evisceration, the nurse asks if

A) bright-red bleeding from the wound edges is seen.
B) fascia or internal organs are visible.
C) fecal material is draining from the wound site.
D) large amounts of pus are draining.

Question 27

The nurse should complete a detailed cognitive assessment on an elderly client before surgery because (Select all that apply)

A) confusion and psychosis are commonly seen in postoperative elderly clients.
B) elders often experience intraoperative strokes.
C) neurologic changes resulting from surgery can last longer in an older client.
D) temporarily impaired cognition can be mistaken for a neurologic event.

Question 28

Assessing unilateral leg edema and warmth in a postoperative client complaining of pain, the surgical unit nurse suspects the complication of

A) hypovolemia.
B) myocardial infarction.
C) pneumonia.
D) thrombophlebitis.

Question 29

The nurse notes that a client's wound is beginning to eviscerate while ambulating. The nurse's initial intervention is to

A) cover the wound with moistened, sterile saline dressings.
B) notify the surgeon immediately.
C) replace the protruding loops of bowel using sterile gloves.
D) return the client to bed as quickly as possible.

Question 30

The nurse explains to the postoperative ambulatory surgery client that his discharge will be delayed because of his

A) blood pressure of (108/64) mm Hg.
B) inability to void.
C) mild incisional discomfort.
D) pulse rate of 92 beats/min.

Question 31

A client has left to go to the operating room. Important supportive interventions the nurse can provide the family include (Select all that apply)

A) asking them for a way to contact them if they leave the area.
B) giving families a way to contact the nurses' station.
C) letting the physician meet with them in person instead of the nurse.
D) showing them where the family waiting room is.

Question 32

Important actions the nurse takes to avoid "wrong site surgery" include (Select all that apply)

A) asking the surgeon to initial the marked site and operate through the initials.
B) calling a time-out to verify right client, right surgical site before starting the operation.
C) having the client mark the surgical site with permanent marker.
D) involving multiple surgeons in the case to check each other.

Question 33

The PACU nurse notes that a client is beginning to become increasingly restless. Nursing assessment includes blood pressure measurements dropping from (120/82) g to (90/60) mm Hg, with heart rate increased to 120 beats/min, and dressings dry and intact. Which action by the nurse takes priority?

A) Increase rate of intravenous (IV) fluids.
B) Increase rate of oxygen (O₂) delivery.
C) Notify the surgeon.
D) Place the client in the Trendelenburg position.

Question 34

In the teaching plan for a client being discharged from the PACU after ambulatory surgery, the nurse should include the instruction to

A) "Be sure that you have someone who can drive you home."
B) "Change your dressing frequently."
C) "Have someone wake you every 2 hours for the first 24 hours."
D) "Measure urine output for 48 hours."

Question 35

The nursing action that should receive highest priority when a client returns from the OR to the PACU is

A) checking the postoperative orders.
B) observing the operative site.
C) positioning the client.
D) receiving the report from OR personnel.

Question 36

The recovery room nurse places the client in the lateral Sims position on admission to the post-anesthesia care unit (PACU) because this position

A) allows the tongue to fall forward.
B) discourages thrombophlebitis.
C) helps stabilize blood pressure.
D) prevents abdominal distention.

Question 37

A client has the nursing diagnosis Fear related to the unknown regarding upcoming surgery. The nurse would know that goals for this diagnosis have been met when the client says "I feel a little better now because

A) a nurse will be with me during the entire experience."
B) I can tolerate anything for 2-3 hours."
C) I know I won't have any complications."
D) this operation is really routine and done all the time."

Question 38

A nurse on the surgical floor has several clients who had surgery during the day. Which of the following actions can this nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.)

A) Encouraging the use of the incentive spirometer
B) Outlining drainage present on dressings
C) Providing comfort measures
D) Recording output from drains
E) Taking vital signs